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Sucking function in infants : the effects of maternal drug abuse Damji, Khadija Katy


Infants of mothers who have received narcotics on a continuous basis during pregnancy are born physically dependent. Drug withdrawal, one of many detrimental effects, is initially the most apparent. Neonatal abstinence syndrome (NAS) was originally described as a generalized disorder characterized by signs of central nervous system hyperirritability, gastrointestinal dysfunction, respiratory distress, and a host of vague autonomic manifestations. Recent studies have suggested that these same signs follow withdrawal from other addicting drugs as well. Feeding problems are the most common and important concomitants of neonatal withdrawal, because sucking function is uncoordinated, ineffectual and poorly sustained. Previous studies have shown a natural history of recovery of sucking dysfunction during recovery from NAS. A disposable and practical apparatus for monitoring nutritive sucking behaviour was developed, based on a prototype previously described in the literature. A weighted scoring system which encompasses the full spectrum of withdrawal signs was also designed. No significant difference in sucking rate was observed between normal and NAS babies on day 1 (p=0.8). There was a highly significant difference on day 2 (prO.0001), day 3 (p=0.0005), and day 4 (p=0.006). No significant difference in nutrient consumption was observed between normal and NAS babies on day 1 (p=0.9) and day 2 (p=0.8). A significant difference was observed on day 3 (p=0.006) and day 4 (p=0.03). A significant inverse correlation was demonstrated between both sucking rate and nutrient consumption with the classical clinical signs of withdrawal over the first two months of life (r=-0.57, -0.51, respectively). The periodic monitoring of sucking rate of the passively addicted infant provides an objective gauge of the seventy of withdrawal in NAS, eliminating the subjectivity of evaluating changes in clinical signs. Therefore, it is recommended that sucking rate measurements be instituted as a standard guide to the management of withdrawal in these infants.

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